Memorial Healthcare System Physician and Provider Careers
MEDICAL DIRECTOR OF CASE MANAGEMENT AND UTILIZATION REVIEW - FT DAYS – MHM
Memorial Healthcare System Physician and Provider Careers, Florida, New York, United States
MEDICAL DIRECTOR OF CASE MANAGEMENT AND UTILIZATION REVIEW - FT DAYS – MHM
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MEDICAL DIRECTOR OF CASE MANAGEMENT AND UTILIZATION REVIEW - FT DAYS – MHM
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Memorial Healthcare System Physician and Provider Careers
The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The Medical Director functions as the primary physician advisor for the hospital and supervises other Physician Advisors for that hospital. As an active member of the UR Committee and in collaboration with it, he identifies opportunities to improve utilization of hospital resources and the quality of patient care. Assists the Case Management staff in resolving patient care issues for referred cases, provides physician education, and assists the hospital and medical staff in developing and promoting resource management goals and objectives. This position reports to the Senior Medical Director of Case Management and Utilization Management.
Responsibilities
Education and Clinical Documentation Improvement: Supports education and clinical documentation improvement. This includes, but not limited to, at least annually educating and communicating to the medical staff the role and benefits of case management, assisting in conducting medical necessity education in collaboration with the Senior Medical Director and Physician Advisors, providing ad hoc education and discussion regarding resource management cases with physicians, assisting physicians in improving the quality of documentation and serving as a liaison between Health Information Management (HIM) Department and the medical staff.
Complex Care Management: Leads Complex Care Management initiatives to reduce complex patient length of stay in conjunction with nursing director of case management; leads hospital complex care meetings in collaboration with case management leadership; responds proactively to escalation of care delays, particularly related to clinical care, physician decision making, and patient/family related discharge barriers; works with physicians on efficient care of observation patients and serves as liaison to insurance companies for prior authorizations creating discharge delay.
Case Management and Utilization Review: Supports the overall enterprise of the Case Management and Utilization Review. Makes decisions on referred individual patient cases regarding pre‑admission authorization, medical necessity and services/setting, appropriateness of admission and continuation stay; provides peer review services for medical necessity of admission or continued stay; supports the Senior Medical Director in medical staff education; assists physicians in improving the quality of their medical necessity documentation; serves as liaison to insurance companies for prior authorizations and removes barriers to discharge; supports case management by attending interdisciplinary rounds (IDR) and provides feedback and suggestions to physicians and CMs; serves as liaison to case management, social workers, nursing staff, individual physicians, and the medical staff; communicates with Centralized UR staff and supports and backs up case management escalations during and outside of IDRs.
Annual Initiatives: Develops UM/resource management studies and projects including fiscal data to improve utilization and patient flow; may include single DRG studies and different physician practice patterns and utilization; works with physicians to change practices and improve outcomes.
Utilization Review Committees: Co‑leads hospital specific UR Committee and is a member of the system UR Committee; makes decisions on referred individual patient cases regarding pre‑admission authorization, medical necessity and services/setting, appropriateness of admission and continuation of stay.
Competencies
Education and Certification Requirements: Medical Doctor (Required) Medical Doctor License (ME LICENSE) – State of Florida (FL) Osteopathic Physician License (OS LICENSE) – State of Florida (FL)
Additional Job Information: Complexity of Work: Essential Competencies and Skills: Excellent customer service and interpersonal skills; Able to effectively present information, both formal and informal; Strong written and verbal communication skills with all levels of internal and external customers; Strong analytical skills; Strong organizational skills and the ability to set priorities and multi‑task; Demonstrated flexibility, teamwork, and accommodation to change in the healthcare environment; Ability to drive results and produce outcomes.
Required Work Experience: Extensive experience in one or more branches of medicine or surgery; at least five (5) post‑training years of medical staff organization/administrative experience in a large acute care hospital.
Additional Education Info: Graduate of a medical school approved by the Council on Medical Education of the American Medical Association.
About Memorial Healthcare System Memorial Healthcare System is one of the largest public healthcare systems in the United States. A national leader in quality care and patient satisfaction, Memorial has ranked 11 times since 2008 on nationally recognized lists of great places to work – in Modern Healthcare magazine, Florida Trend magazine and Becker’s Hospital Review, just to name a few.
Memorial’s facilities include its flagship, Memorial Regional Hospital, one of the largest in Florida; Memorial Regional Hospital South; Joe DiMaggio Children’s Hospital, the only freestanding children's hospital in Broward and Palm Beach counties; Memorial Hospital West; Memorial Hospital Miramar; Memorial Hospital Pembroke; and Memorial Manor, a US News five‑star‑rated nursing home.
Memorial’s work environment has been rated by employees and physicians alike as an open‑door, inclusive culture that is committed to safety, transparency and, above all, outstanding service to patients and families.
About South Florida South Florida offers a dynamic urban/suburban lifestyle with an abundance of cultural and recreational amenities, miles of beautiful beaches, top‑rated golf courses, zoos and wildlife refuges, a vibrant arts community, museums and world‑class dining. South Florida’s high quality of life – including year‑round summer weather, exciting multiculturalism and no state income tax – attracts new residents from all over the country and around the world.
Seniority level Director
Employment type Full‑time
Job function Health Care Provider
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MEDICAL DIRECTOR OF CASE MANAGEMENT AND UTILIZATION REVIEW - FT DAYS – MHM
role at
Memorial Healthcare System Physician and Provider Careers
The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The Medical Director functions as the primary physician advisor for the hospital and supervises other Physician Advisors for that hospital. As an active member of the UR Committee and in collaboration with it, he identifies opportunities to improve utilization of hospital resources and the quality of patient care. Assists the Case Management staff in resolving patient care issues for referred cases, provides physician education, and assists the hospital and medical staff in developing and promoting resource management goals and objectives. This position reports to the Senior Medical Director of Case Management and Utilization Management.
Responsibilities
Education and Clinical Documentation Improvement: Supports education and clinical documentation improvement. This includes, but not limited to, at least annually educating and communicating to the medical staff the role and benefits of case management, assisting in conducting medical necessity education in collaboration with the Senior Medical Director and Physician Advisors, providing ad hoc education and discussion regarding resource management cases with physicians, assisting physicians in improving the quality of documentation and serving as a liaison between Health Information Management (HIM) Department and the medical staff.
Complex Care Management: Leads Complex Care Management initiatives to reduce complex patient length of stay in conjunction with nursing director of case management; leads hospital complex care meetings in collaboration with case management leadership; responds proactively to escalation of care delays, particularly related to clinical care, physician decision making, and patient/family related discharge barriers; works with physicians on efficient care of observation patients and serves as liaison to insurance companies for prior authorizations creating discharge delay.
Case Management and Utilization Review: Supports the overall enterprise of the Case Management and Utilization Review. Makes decisions on referred individual patient cases regarding pre‑admission authorization, medical necessity and services/setting, appropriateness of admission and continuation stay; provides peer review services for medical necessity of admission or continued stay; supports the Senior Medical Director in medical staff education; assists physicians in improving the quality of their medical necessity documentation; serves as liaison to insurance companies for prior authorizations and removes barriers to discharge; supports case management by attending interdisciplinary rounds (IDR) and provides feedback and suggestions to physicians and CMs; serves as liaison to case management, social workers, nursing staff, individual physicians, and the medical staff; communicates with Centralized UR staff and supports and backs up case management escalations during and outside of IDRs.
Annual Initiatives: Develops UM/resource management studies and projects including fiscal data to improve utilization and patient flow; may include single DRG studies and different physician practice patterns and utilization; works with physicians to change practices and improve outcomes.
Utilization Review Committees: Co‑leads hospital specific UR Committee and is a member of the system UR Committee; makes decisions on referred individual patient cases regarding pre‑admission authorization, medical necessity and services/setting, appropriateness of admission and continuation of stay.
Competencies
Education and Certification Requirements: Medical Doctor (Required) Medical Doctor License (ME LICENSE) – State of Florida (FL) Osteopathic Physician License (OS LICENSE) – State of Florida (FL)
Additional Job Information: Complexity of Work: Essential Competencies and Skills: Excellent customer service and interpersonal skills; Able to effectively present information, both formal and informal; Strong written and verbal communication skills with all levels of internal and external customers; Strong analytical skills; Strong organizational skills and the ability to set priorities and multi‑task; Demonstrated flexibility, teamwork, and accommodation to change in the healthcare environment; Ability to drive results and produce outcomes.
Required Work Experience: Extensive experience in one or more branches of medicine or surgery; at least five (5) post‑training years of medical staff organization/administrative experience in a large acute care hospital.
Additional Education Info: Graduate of a medical school approved by the Council on Medical Education of the American Medical Association.
About Memorial Healthcare System Memorial Healthcare System is one of the largest public healthcare systems in the United States. A national leader in quality care and patient satisfaction, Memorial has ranked 11 times since 2008 on nationally recognized lists of great places to work – in Modern Healthcare magazine, Florida Trend magazine and Becker’s Hospital Review, just to name a few.
Memorial’s facilities include its flagship, Memorial Regional Hospital, one of the largest in Florida; Memorial Regional Hospital South; Joe DiMaggio Children’s Hospital, the only freestanding children's hospital in Broward and Palm Beach counties; Memorial Hospital West; Memorial Hospital Miramar; Memorial Hospital Pembroke; and Memorial Manor, a US News five‑star‑rated nursing home.
Memorial’s work environment has been rated by employees and physicians alike as an open‑door, inclusive culture that is committed to safety, transparency and, above all, outstanding service to patients and families.
About South Florida South Florida offers a dynamic urban/suburban lifestyle with an abundance of cultural and recreational amenities, miles of beautiful beaches, top‑rated golf courses, zoos and wildlife refuges, a vibrant arts community, museums and world‑class dining. South Florida’s high quality of life – including year‑round summer weather, exciting multiculturalism and no state income tax – attracts new residents from all over the country and around the world.
Seniority level Director
Employment type Full‑time
Job function Health Care Provider
#J-18808-Ljbffr